Greenway and athenahealth are two of the more forward-thinking companies in health IT. Although they do have some older technologies in the background, they’ve adopted most of the newer tech stacks when and where possible.

Most importantly, both companies view themselves as platforms on which other apps can be built. They see themselves as app platforms and distributors, similar to the Apple and Google model and their respective iOS and Android app stores.

A common example of a data API is when a third-party iPhone or Android app pulls up your contact list. A common example of a logical AP is integrating camera functionality into an app. In both examples, Google and Apple performed an enormous amount of work to build contact lists and a camera. They exposed the data and logic behind each function so that developers could integrate those functions into their own apps.

Let’s take a look at the athena and Greenway platforms.

It’s important to note that athena hasn’t actually launched anything of substance. Its current "release" is a soft launch that was timed for HIMSS13. The athena app store won’t be live for another few months at least.

Greenway beat athena to the market by a mile and finished the marathon before anyone else even started. Greenway launched its app store for HIMSS12. It has provided a few updates API updates since then, though I haven’t seen any remarkable jumps forward since the initial launch.

Next, let’s look at technology. Athena is only exposing modern, RESTful APIs. Athena isn’t exposing any logical APIs, only data. That’s not necessarily a bad thing, as data is more important, but it means that third-party apps can’t plug into athena’s existing workflows. All athena third-party apps must exist as standalone, independent entities.

For developers, RESTful APIs are awesome to work with. In many cases, they require just 1-2 lines of code to get a data back in a predefined, Web standards compliant structure (usually JSON).

Greenway doesn’t provide any logical APIs either. Unfortunately, they live on an older tech stack, so not all of their data APIs are RESTful. Many of them use the older SOAP format, which is much more cumbersome for developers to work with. Additionally, some of Greenway’s documentation is lacking. To be fair, that’s still better than athena, which provides no documentation at all since nothing has actually launched.

Both Greenway and Athena hired Mashery to help build their application platforms. Mashery helps technology companies build application platforms and expose APIs. It helps them make decisions about when and where to expose data, how to structure APIs, how to write documentation, and how to evangelize and entice developers to write on top of their platforms. Mashery is widely considered to be the best in the API management business, so it’s no surprise that both athena and Greenway turned to them. Neither company had experience building an application platform, so it was smart to bring in outside help.

Let’s take a quick look at business practices and models. Greenway’s model is not particularly friendly towards startups. They told my company to come back when we had customers, and more importantly, revenue. Greenway only wants to work with established companies that have real customers and real revenue.

From Greenway’s perspective, if they can’t monetize the relationship on Day One, it’s not worth pursuing. While I respect that logic, that defeats the entire premise of an app store — self-proclaimed "innovation at lightning speed." Quite a few pre-revenue companies innovate much faster than those with customers who slow them down.

Greenway also told me explicitly that if the company ever decides that it wants to be in my business (or any other developers’ business), it will gladly copy and steamroll me. Although I disagree with its thinking, it aligns with its business model: selling software as a service. Sell more modules and charge more money. I think the best thing Greenway can do is to grow the app store as fast as possible and create developer and customer lock-in. Stickiness is more valuable than marginal revenue.

Athena on the other hand is much more like Apple and Google. They don’t play favorites with their developers. Whether you’re a guy in a garage living on ramen or a $50M company, they treat you the same. This model reflects athena’s business model: give away software for free to sell administrative services and take money off the back end.

Athena doesn’t care if you replicate every function they offer and do it 10 times better. As long as the practice is an athena customer, athena is monetizing the billing and collections at the end of the day, not the use of any particular function of its many first-party apps. Athena’s interests are more aligned with those of its developers and customers.

I should make a grand statement of which app store is better, but that’s silly. Athena’s isn’t even out yet and I’m inherently biased against Greenway since they told me to go away. I would rather level the playing field, make knowledge public, and encourage all of the EHR vendors to learn from both the successes and the mistakes of athenahealth and Greenway. Hopefully other EHR vendors can learn to make better decisions on behalf of their customers and third-party developer partners.

EHR vendors, please, for the love of God, open up your platforms. It’s in your long-term best interest. EHR churn is rampant and only getting worse. Stickiness is way more valuable than marginal revenue. You’ve already built a castle, now build a moat. I’m especially looking at you, Epic, Cerner, Meditech, and McKesson.

Kyle Samani is a healthcare technology entrepreneur who is passionate about healthcare and technology startups.

Release The Kraken

Classic Greenway response. One of many examples: I was giving a seminar once and mentioned out loud that I wondered how their EHR conversion from a third, mutual competitor was going for one of the practices in the room. Two days later, I got a call from a Gw Sales VP to tell me how great it was going (it wasn’t, but that’s another story). Once he realized that I’m a vendor, he told me, “You should just get out of this business. Your company is going to be gone in a year or two anyway. Save your clients some grief and send me all of their contact information.”

I wish I could remember his name so I could send him our KLAS scores. I’m not sure there’s a single category at which they beat us.

mhn125

Very informative, Kyle. I learned some terms with which I had no previous knowledge. I like the way you write.

Curious consultant

How would you compare these vendors with eClinicalWorks, which seems to have a substantial ambulatory market share?

kylesamani

Curious consultant

I haven’t used the front-ends of those systems enough to comment on overall quality. I’ve learned everything about these companies by following the industry religiously for years, and from dealing with them directly as a potential 3rd party developer, plus a little technical research.

kylesamani

response to what?

travisjgood

Also interesting re Mashery – it was recently acquired by Intel. I’ve asked people at Intel about the strategy for Mashery in healthcare but didn’t get very far.

Duf

The good ol’ boys at Greenway are definitely enamored with their “open” API platform, but it doesn’t hide the fact they’re selling access to a clunker.